title: Mortality and health services utilisation among older people with advanced cognitive impairment living in residential care homes.
abstract: OBJECTIVE
  To study the demography, clinical characteristics, service utilisation, mortality, and predictors of mortality in older residential care home residents with advanced cognitive impairment.
  
  
  METHODS
  Cohort longitudinal study.
  
  
  METHODS
  Residential care homes for the elderly in Hong Kong West.
  
  
  METHODS
  Residents of such homes aged 65 years or more with advanced cognitive impairment.
  
  
  RESULTS
  In all, 312 such residential care home residents (71 men and 241 women) were studied. Their mean age was 88 (standard deviation, 8) years and their mean Barthel Index 20 score was 1.5 (standard deviation, 2.0). In all, 164 (53%) were receiving enteral feeding. Nearly all of them had urinary and bowel incontinence. Apart from Community Geriatric Assessment Team clinics, 119 (38%) of the residents attended other clinics outside their residential care homes. In all, 107 (34%) died within 1 year; those who died within 1 year used significantly more emergency and hospital services (P<0.001), and utilised more services from community care nurses for wound care (P=0.001), enteral feeding tube care (P=0.018), and urinary catheter care (P<0.001). Independent risk factors for 1-year mortality were active pressure sores (P=0.0037), enteral feeding (P=0.008), having a urinary catheter (P=0.0036), and suffering from chronic obstructive pulmonary disease (P=0.011). A history of pneumococcal vaccination was protective with respect to 1-year mortality (P=0.004).
  
  
  CONCLUSIONS
  Residents of residential care homes for the elderly with advanced cognitive impairment were frail, exhibited multiple co-morbidities and high mortality. They were frequent users of out-patient, emergency, and in-patient services. The development of end-of-life care services in residential care homes for the elderly is an important need for this group of elderly.
authors.affiliation: Department of Medicine and Geriatrics, Fung Yiu King Hospital, 9 Sandy Bay Road, Pokfulam, Hong Kong.
authors.forename: James K H
authors.initials: JK
authors.lastname: Luk
authors.forename: W K
authors.initials: WK
authors.lastname: Chan
authors.forename: W C
authors.initials: WC
authors.lastname: Ng
authors.forename: Patrick K C
authors.initials: PK
authors.lastname: Chiu
authors.forename: Celina
authors.initials: C
authors.lastname: Ho
authors.forename: T C
authors.initials: TC
authors.lastname: Chan
authors.forename: Felix H W
authors.initials: FH
authors.lastname: Chan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D015331:Cohort Studies; D015897:Comorbidity; D004750:Enteral Nutrition / Q000706:statistics & numerical data; D005260:Female; D016330:Frail Elderly; D006301:Health Services Needs and Demand; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006723:Hong Kong; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D012307:Risk Factors; D013727:Terminal Care / Q000458:organization & administration*
keywords: Cognition disorders; Frail elderly; Homes for the aged; Long-term care; Mortality